Public Health Citizen Science - Citizen Science: Theory and Practice

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Nov 9, 2017 - will refer to them here as “citizen scientists.” The stages of the project were training of citizen scientists, data collection by citizen scientists, and ...
Den Broeder, L. et al 2017 Public Health Citizen Science; Perceived Impacts on Citizen Scientists: A Case Study in a Low-Income Neighbourhood in the Netherlands. Citizen Science: Theory and Practice, 2(1): 7, pp. 1–17, DOI: https://doi.org/10.5334/cstp.89

RESEARCH PAPER

Public Health Citizen Science; Perceived Impacts on Citizen Scientists: A Case Study in a Low-Income Neighbourhood in the Netherlands Lea Den Broeder*,‖, Lidwien Lemmens*, Serfanim Uysal†, Karin Kauw†, Jitske Weekenborg‡, Michaela Schönenberger§, Simone Klooster-Kwakkelstein‖, Mieke Schoenmakers¶, Willie Scharwächter**, Annemarije Van de Weerd‖, Samira El Baouchi*, Albertine Jantine Schuit* and Annemarie Wagemakers†† Citizen science – the active participation of lay people in research – may yield crucial local knowledge and increase research capacity. Recently, there is growing interest to understand benefits for citizen scientists themselves. We studied the perceived impacts of participation in a public health citizen science project on citizen scientists in a disadvantaged neighbourhood in the Netherlands. Local citizen scientists, characterised by low income and low educational level – many of whom were of migrant origin – were trained to interview fellow residents about health-enhancing and health-damaging neighbourhood features. Experiences of these citizen scientists were collected through focus groups and interviews and analysed using a theoretical model of potential citizen science benefits. The results show that the citizen scientists perceived participation in the project as a positive experience. They acquired a broader understanding of health and its determinants and knowledge about healthy lifestyles, and took action to change their own health behaviour. They reported improved self confidence and social skills, and expanded their network across cultural boundaries. Health was perceived as a topic that helped people with different backgrounds to relate to one another. The project also induced joint action to improve the neighbourhood’s health. We conclude that citizen science benefits participants with low educational or literacy level. Moreover, it seems to be a promising approach that can help promote health in underprivileged communities by strengthening personal skills and social capital. However, embedding projects in broader health promotion strategies and long-term engagement of citizen scientists should be pursued to accomplish this. Keywords: public health; community; disadvantaged groups; residents; citizen science experiences; neighbourhood Introduction Citizen science – the active participation of lay people in scientific research in ways other than as serving as research objects or respondents – has important advantages for science. It adds knowledge and insights that may help solve complex problems (Fischer 2000) and it may reduce the work load for researchers in * National Institute for Public Health and the Environment, NL Eigenwijks, NL



Bijzonder Wonen, NL



Municipal Health Authority Amsterdam, NL

§

Amsterdam University of Applied Sciences, NL



De Zoete Appel, NL



Scharwächter leefstijlspecialist, NL

**

Wageningen University and Research Centre Health and Society, NL

††

Corresponding author: Lea Den Broeder ([email protected])

labour-intensive projects, for example, by gathering large amounts of data or collecting data that are otherwise difficult to obtain owing to factors such as geographic spread or hard-to-reach populations (Gommerman and Monroe 2012). The citizen science approach also yields benefits for its participants, for example, by enhancing scientific literacy or public knowledge about specific topics (Bonney et al. 2009, Brossard et al. 2005, Cronje et al. 2011, Den Broeder et al. 2016). One of the fields in which the impacts of citizen science could be particularly important is public health and the promotion of health research. Community participation is strongly advocated in health promotion, for example, the Ottawa Charter on health promotion emphasises “strengthening community action” as one of its core strands of action (World Health Organization 1986). Partnerships among researchers and community members are considered to be important opportunities for

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empowering communities to take action for better health (Minkler 2000, Israel et al. 1998, Brown 1997, South and Phillips 2014, Wagemakers et al. 2008, Wagemakers et al. 2010, Horowitz et al. 2009). In practice, the knowledge base for health promotion strategies is often limited to expert-driven knowledge and an epidemiological paradigm (Vaandrager et al. 2011, Minkler et al. 2003). In Amsterdam, the Netherlands, local policy makers aimed to change that by setting up a citizen science project to develop a “bottom-up” health policy for a disadvantaged neighbourhood. The project’s main goal was to yield important grassroots information on views, needs, and concerns of the community that could assist in designing a more inclusive policy for this so-called “priority” neighbourhood. Through this project, community members served as peer interviewers of their fellow residents providing important contextual and “insider” information helpful in analysing project data. The project may therefore be classified as a collaborative project in the classification of Shirk et al. (2012). In the process, the project team ensured that the project also benefited the participating citizen scientists by enhancing their understanding of the broader determinants of health and their personal competencies. Because the project was intended to provide new opportunities and possibilities for residents to become actively engaged in improving the community’s health, assessing project impacts on its citizen scientist participants was a core element of the project’s design. This paper aims to contribute to knowledge about the impacts of participation on citizen scientists in the field of public health, with a focus on disadvantaged groups. Our main research question was: What impacts were experienced by citizen scientists participating in a public health research project? Methods

Project setting

The project took place in 2014–2015 in Slotermeer, a disadvantaged neighbourhood in Amsterdam, the Netherlands. A project team led by “Eigenwijks,” a local community work organisation that represents, supports, and activates Slotermeer residents, was formed to set up the project. The evaluation of project impacts on its citizen scientist participants was carried out by researchers who served on the project team. Slotermeer faces many health and community issues including obesity, mental health, loneliness, poverty, and a poor liveability. More than 60% of the population is of non-western migrant origin (Gemeente Amsterdam 2015a). Residents are considered as “hard to reach” for local public health policy makers, and this project was initiated by the local District Council. Although originally planned for 2014 it was extended to 2015 owing to the enthusiasm of the District Council about its results. Therefore, one group of citizen scientists was enrolled in 2014 and a second group in 2015. The project objective was to gather information about resident views concerning potential neighbourhood health assets as a basis for determining local policy. Participants

in the project were named “Health Ambassadors,” but we will refer to them here as “citizen scientists.” The stages of the project were training of citizen scientists, data collection by citizen scientists, and reporting and analysis of results. Citizen scientist training

Participants were trained in groups of five to eight through an “experiential learning” approach with a focus on learning processes rather than on attaining fixed end points (Kolb 1984). The citizen scientists were stimulated to link their personal day-to-day experiences to the training content, thus creating new knowledge that combines both. Training was developed and carried out incrementally (MS, WS) with support and input from the project group (SU, KK, SKK, MS, LDB) as well as from the participants. For example, the participants asked for extra help to organise interviews. Therefore, an additional meeting was organised as a kick-off to the interview stage, and a printed guideline about how to organise interviews was developed and provided. Training addressed three main topics. First, the perspective on health as “the ability to adapt and selfmanage in the face of social, physical, and emotional challenges” (Huber et al. 2011) was explained. Second, techniques to recruit interviewees and to carry out group interviews based on “motivational interviewing” (Miller and Rollnick 2007) were described. Third, to enhance the citizen scientists’ understanding of the broadness of factors that may impact community health, a Dutch translation of the model of sustainable neighbourhoods developed by Egan (2004) was explained and discussed. Training took place over three half-day sessions within a six-week time span. The training sessions were evaluated by a questionnaire focusing on satisfaction level of the citizen scientists with the training in general, both as a preparation for the research work and as a process. It also contained open-ended questions asking about further needs. The overall satisfaction level with the training was 8.2 on a 10-point scale for 2014 and 8.0 for 2015. Several citizen scientists from the 2014 group suggested better matching of participants with different educational or language levels in different groups. This was implemented in 2015; citizen scientists then rated the training level as well-matched to their needs and knowledge level. A schematic overview of the training is provided in Table 1. Data collection by citizen scientists

Citizen scientists collected data during a six-week period launched by a kick-off dinner that celebrated the finalisation of the training and provided instructions and printed guideline to help participants set up interviews. Interview topics included what aspects of the neighbourhood residents viewed as health enhancing (health assets) and what aspects needed to be improved (barriers for health). The citizen scientists also asked residents which actions the residents themselves could develop to improve the community’s health. The citizen scientists were trained to carry out group interviews but were invited to also use

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Table 1: Training overview. Session

Topics

Methods

Training day 1

Introduction of group members and Group discussion, storytelling, trainers to one another mini lectures

Materials Flip chart

Introduction to the project

Training day 2

Health definitions (including “Positive Health”) Interview techniques and attitudes

Training day 3

Interview techniques and attitudes Health determinants (including Egan model)

Kick-off meeting

Next steps in project Recruitment of interviewees

Group discussion, small group Powerpoint slides, video examples assignments, video, mini lectures of interview techniques, flip chart, fill-in forms to reflect on video Group discussion, video, mini Powerpoint slides, video examples lectures of interview techniques, flip chart

Joint dinner, group instruction

Reporting

Handout with tips for planning of interviews

Next steps

Reporting form “My Group’s Story”

other methods, such as one-on-one interviews, if they preferred. Indeed, the citizen scientists used a large variety of interview methods, in varied settings, and with many types of interviewees. Interviews took place in homes, schools, shops, community meeting places, and in the street. Some citizen scientists interviewed family and friends, others interviewed random people, and others purposefully searched for different “voices,” for example, by interviewing youngsters or older people. According to the citizen scientists, these groups were often not listened to by neighbourhood health professionals. Citizen scientists received practical support from neighbourhood community workers assisted by students from the Amsterdam University of Applied Sciences (SU, KK, JW, and SKK). Support included developing personal strategies to engage residents in interviews. The citizen scientists recorded the results of their interviews on easyto-fill out forms and interviewed a total of 316 fellow residents; one trained citizen scientist did not manage to carry out interviews owing to personal circumstances but remained a group member in all other project stages. Data reporting and analysis by citizen scientists

The third project stage, reporting of results and analysis, consisted of discussion of the interview results in focus groups and jointly interpreting and explaining the data collected, after which these data were further analysed (LdB) yielding an overview of health enhancing neighbourhood features as well as barriers brought forward by the residents interviewed (Table 2). Results were presented back to the citizen scientists, to the community, and to the District Council in a report and two brochures (den Broeder et al. 2015, RIVM 2015, RIVM 2016). Moreover, a meeting with all citizen scientists was organised in which these end results were discussed, with the aim of developing recommendations for action, to be taken either by the District Council, by professionals in the neighbourhood, or by residents themselves. After their interview activities, both the 2014 and 2015 citizen scientist groups organised a neighbourhood

health festival in the community centre, supported by community workers (KK, SU, and JW). At the festival each citizen scientist received a “Health Ambassador” certificate confirming their participation in the project. Project results were used as input for the District Council’s District Development Strategy. For example, citizen scientists have become actively engaged in the development of a new programme to combat loneliness in the neighbourhood, one of the topics they discussed during the analysis stage. Moreover, the citizen scientists are explicitly mentioned in the District Development Plans for 2016 and 2017, and the intention is that a larger network of “ambassadors for health” will be developed for the other neighbourhoods in the larger Nieuw-West area (Gemeente Amsterdam 2015b, Gemeente Amsterdam 2016). Research study design

To study the project impacts on the citizen science participants we applied an action research approach; activities with and by citizen scientists were closely linked to research activities carried out to evaluate the perceived impacts of the project. For example, focus groups with the citizen scientists were organised to collect data about how they perceived impacts of the project, but also for them to share and discuss the results of their interviews with each other. Mixed methods were applied as a concurrent triangulation strategy (Creswell 2009). An overview of the project after the initial recruitment, for the citizen scientists enrolled in both 2014 and 2015, is provided in Figure 1. Selection of citizen scientists to study

All citizen scientists who remained engaged throughout the project were included in this study. They had been selected by the local community work organization, using its resident network in the neighbourhood. They were invited in an informal way, by phone, in person, or in groups gathered at the community center (SU, KK). Several additional persons, having heard about the project from friends in the neighbourhood, came forward without

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Table 2: Neighbourhood features brought forward by residents (N = 316) in the interviews carried out by the citizen scientists. Health enhancing neighbourhood features

Barriers for health in the neighbourhood

Attractive and abundant public greenery, in particular the Sloterplas lake

Insufficient information about healthy lifestyles, insufficient health promotion activities

Further enhancement options: Public toilets, more and safer; well-kept children’s playgrounds; free or inexpensive public sports facilities for adults Transport and connectivity is rated good. Public transport is rated as excellent Further enhancement option: Improve traffic safety around schools

One-sided local economy with a small variety of shops; abundance of unhealthy food choices and junk food stores Unhealthy behaviour of people in the streets, in particular junk food and soft drink consumption Poverty as such is a health threat; moreover it is a barrier for people to adopt healthy life styles

Poor social cohesion and lack of intercultural exchange, loneliness and a sense of unsafety; lack of meeting places for Further enhancement option: Better communication to provide social contact residents with information about the availability of these Litter in public space, lack of litter disposal facilities and services resulting pests inadequate environmental behaviour of Social and health facilities are abundant and good quality

residents Poor quality housing, unhealthy indoor environment and dwellings that are too small for the size of families living there

Figure 1: Project overview. Items in the left and right columns are citizen scientists’ activities including training; items in the middle column are research activities to study the impacts of their participation as citizen scientists. being invited. In 2014, those that came forward after the start of the training were placed on a waiting list for the 2015 group. Selection criteria were being a resident of Slotermeer; being engaged in social activities in the neighbourhood; having an interest in community health issues; and being able to speak and understand Dutch on a basic level. Persons who were not selected were invited

to participate in other community centre activities such as courses or social groups. Initially, 42 citizen scientists were recruited. In 2014, six persons dropped out. Four of these decided not to participate immediately after the initial focus groups, which they had attended out of personal interest but not with the aim of participating in the project. Two other citizen scientists dropped out later due to personal

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circumstances. In 2015, one person dropped out for personal reasons, thus 35 citizen scientists remained engaged throughout the project. All were informed, beforehand, that they would receive a financial incentive of €150.00 for their citizen science work after completion of the second round of focus groups. Data collection about citizen scientists

Focus groups with both groups of citizen scientists (2014, 2015) were held both before their citizen scientist training and after they had carried out their citizen science task (LDB, MS, WS, KK, AEB). The 45-minute focus groups were held in the community centre, and a focus group protocol was applied. In total 10 focus group with 4–8 persons were conducted. All focus groups were videorecorded and transcribed verbatim. The main topic in the focus groups held before the project activities began was how the citizen scientists perceived the health of the neighbourhood. Focus groups were started off by filling out a “thermometer” for the health of the neighbourhood; these scores were then placed on a large wall poster (Figure 2). After this, a discussion took place about health in general and the health of the neighbourhood. The focus groups also served to facilitate the citizen scientists in getting acquainted with the project team and each other. In the focus groups held after the citizen scientists had carried out their citizen science tasks, two topics were central: The information participants had collected and their personal experiences as citizen scientists. All citizen scientists were also invited as respondents for post-project semi-structured interviews about their experiences as citizen scientists (opportunity sampling) (AVDW, LDB). Average interview duration was 30 minutes, and interviews were recorded and transcribed verbatim. Examples of questions were: “How do you feel about the project Healthy Slotermeer?”, “What is your own role in the project?”, and “What has the project meant to you as a person?”. After the interviews, the citizen scientists received a €10.00 gift cheque as an acknowledgement. At focus groups conducted both before and after project activities, the citizen scientists filled out a structured questionnaire. Items included personal data, two visual analogue scales rating personal and neighbourhood health (de Boer et al. 2004), the Chew Three-item Health Literacy (HL) scale, Dutch version (Fransen et al. 2011), and the 13 item Sense Of Coherence (SOC) scale (Dutch version) (Swan et al. 2015). The Chew HL scale measures functional literacy level needed to understand written health information by means of three five‐point Likert scale questions. The SOC scale is a validated scale consisting of 13 seven-point Likert scale questions measuring the degree to which a person experiences reality as comprehensible, meaningful, and manageable; a high SOC contributes to health and health behaviour. SOC may increase over the life span, and focused interventions may support this. Therefore, SOC is a key concept in asset approaches in health promotion (Eriksson and Lindström 2005, Nilsson et al. 2010, Super et al. 2014). The SOC-13 scale has been translated and applied in different parts of the world with different groups; a worldwide

Figure 2: Wall poster displaying citizen scientists’ rating of the neighbourhood’s health. The person in this photo is a research assistant. Informed consent for use of this photo was obtained. review looking into the validity of the scale suggests that it is interculturally stable (Eriksson and Lindström 2005) The SOC scale copyright holders granted permission for its use in this study. Analysis of data about citizen scientists

Analysis of the qualitative data was carried out through descriptive and thematic coding (Tracy 2013). The codebook for descriptive coding was based on a model of benefits for citizen scientists that we presented in an earlier paper (Den Broeder et al. 2016). This model contains four clusters of potential direct impacts of participation in a public-health citizen science project on the citizen scientists (Figure 3). The first cluster refers to increase of health literacy, conceptualised as an asset: “a person’s ability to access, understand, and use health information in ways that promote and maintain good health” (Nutbeam 2008: 2076). The second cluster refers to empowerment of citizen scientists to take action on a personal or collective level. The third cluster refers to community building, social capital, social learning, and trust. The fourth cluster refers to change of attitudes, norms and values. These clusters are marked 4, 5, 6 and 7 in the figure. The codebook was tested and refined by pilot coding of two interviews (LL, LdB), then applied to all data, i.e., interview and focus group transcripts (the codebook and code descriptions are presented in Table 3). Two coders (LDB, LL) carried out coding using MaxQDA software, version 12. Coding outputs were compared; decisions on codes assigned were taken based on consensus. After descriptive coding, output lists per code

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Figure 3: Model of citizen science benefits (Source: Den Broeder et al. 2016). and per code set were analysed and recurrent themes identified for each code set (thematic analysis). Themes were then clustered across code sets into broader, more generic themes describing citizen scientists’ experiences and perceptions (LDB, LL, AW, JS). Coding outputs of focus groups held before training of the citizen scientists were used solely to verify changes of perception (or lack of change) reported by citizen scientists. We carried out descriptive analysis of the questionnaire data. Responses for the HL scale were scored from 0 to 4, added, and averaged. An average score ≥2 indicates adequate HL; scores under 2 indicate inadequate HL (Fransen et al. 2011). Scores on SOC were calculated by adding up the points (1–7) marked for each item. Similar to previous research with this scale in the Netherlands, we rated SOC ≤ 67 as “low” and SOC ≥ 68 as “high” (Swan et al. 2016). The significance of changes in scores before and after participation in the project were analysed by performing paired T-tests on scores for personal and neighbourhood health, HL, and SOC. Results

Background of the citizen scientists

Most citizen scientists were women and most were members of cultural minority groups and/or migrants. Most had a moderate educational level; several nonwestern migrants stated that they had followed a university education in their country of origin. The income level of the citizen scientists was low to moderate – four had paid work while the others were homemakers, unemployed, pensioners, or received social benefits. One was a student. Background data of the citizen scientists is presented in Table 4. Except for gender composition, the citizen scientist groups resemble the neighbourhood’s population, with 26% unemployment (homemakers, in

the Netherlands, are not registered as unemployed) and 28% of the households combining low income with low educational level of the head of household. In Slotermeer, more than 60% of the inhabitants are of migrant origin, in particular Turkish and Moroccan, and 37 to 41% of the inhabitants have low literacy levels (Gemeente Amsterdam 2015a). Focus group and interview results

All quotes hereafter are Dutch to English translations. As some citizen scientists’ mastery of Dutch was basic, the original quotes were not always well formed. These were corrected at translation to improve readability of this paper. Generic results

The main reason that the citizen scientists participated was that they were enthusiastic about the theme “health” and felt this was a topic worth working on. They felt the neighbourhood could be improved in that respect and they wished to contribute to that effort: “Why I joined the project? Because I think it is something good for our neighbourhood. Health is important for us, because the dark spot in Amsterdam is this neighbourhood here, it is Slotermeer.” (interview citizen scientist 30) Other motivations were that they were keen to meet new people and learn something new. Some citizen scientists with a migrant background saw the project as an opportunity to get in touch with people outside their own cultural group, thereby developing their language skills: “I thought, this is a good project; I should participate, even though I don’t speak Dutch very

Include when features of the community are referred to

Include when one’s own contribution to collective action options are referred to

Include when community options for action are referred to

Include when one’s own options are compared to others, implicitly or explicitly

Include when personal options for action are referred to

Exclude when not referring to health, health care, or health behaviour

Include when one’s own ability is compared to others, implicitly or explicitly

Comm Trust Referring to experience of trust

Comm Social learning Referring to shared learning experience

Include when referring to trust in trainers

Include when referring to trust in project team

Include when referring to trust in other group members

Include when shared experience is referred to

Include when learning is referred to

(contd.)

Exclude when referring to trust in people or institutions outside project scope

Exclude in case of referring to individual learning

Exclude when referring solely to other people’s networks

Exclude when referring solely to the networks as such

Exclude when solely referring to individual features of persons

Exclude when referral is solely to options in other communities

Exclude when referral is solely to other’s options

Exclude when referring solely to the usefulness or applicability of the information

Exclude when referral is solely to other’s abilities

Include when respondent refers to own abilities

Comm Social capital Include when referring to one’s own networks/access to Referring to one’s own social network and access to broader networks social networks

Comm Community building Referring to contribution to greater social cohesion in or quality of the community

Emp Options for collective action Referring to possibilities to take action with other community members

Emp Options for personal action Referring to possibilities to take action in personal life

HL Applying health info Referring to the ability to apply information about health, health care, health behavior to one’s own situation

Exclude when not referring to health, health care, or health behaviour

Include when one’s own ability is compared to others, implicitly or explicitly

Exclude when referring solely to quality or accessibility of the information

Exclude when referral is solely to other’s abilities

Include when respondent refers to own abilities

Exclude when not referring to health, health care, or health behaviour

Include when one’s own ability is compared to others, implicitly or explicitly

HL Understanding info Referring to the ability to understand information about health, health care, health behavior

Exclude when referral is solely to other’s abilities

Include when respondent refers to own abilities

HL Finding info Any remark referring to the ability to find information about health, health care, health behavior

Exclusion criteria

Inclusion criteria

Code name/description

Table 3: Code book and code descriptions.

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Include when attitudes are changed

Att Attitude change Referring to adoption of new attitudes, i.e., systems of thought, opinions, tendencies

Exclude when referring solely to positive points as perceived by other people

Include when positive points are mentioned

Include when negative points or points of improvement are mentioned

OC Positive points Referring to positive points of the project as mentioned by the citizen scientist

OC Negative points/points of improvement Referring to negative points or points of improvement of the project as mentioned by the citizen scientist

Exclude when referring solely to other people’s reasons to participate Exclude when referring solely to other effects experienced by other people

OC Motivation to participate Include when reasons to participate in the project are Referring to motivation of citizen scientist to participate in mentioned the project

OC Other effects of project Include when other effects of the projects on the citizen Referring to other effects of the project as perceived by the scientist are experienced citizen scientists, e.g., it brought them fun

Exclude when referring solely to negative points or points for improvement as perceived by other people

Exclude when referring solely to other people’s values

Exclude when referring solely to collective norms

Exclude when referring solely to other people’s norms

Exclude when referring solely to other people’s attitudes

Exclusion criteria

Att Change of values Include when values are changed Referring to adoption of new values, i.e., views on what are Include when existing values are reinforced important aspects in life that underpin one’s opinions and Include when existing values are further developed behaviours

Att Change of norms Include when norms are changed Referring to adoption of new norms, i.e., what is considered Include when existing norms are reinforced positive/negative, appropriate/inappropriate Include when existing norms are further developed

Include when existing attitudes are further developed

Include when existing attitudes are reinforced

Inclusion criteria

Code name/description

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Table 4: Background of citizen scientists. Personal characteristics (N = 35) Gender Female Male

N 32 3

Age 21–30 31–40 41–50 51–60 >60 Unknown

N 3 10 15 1 4 2

Country of birth Morocco Netherlands Turkey Egypt Surinam Other non-western Missing

N 17 6 3 2 2 2 3

Socioeconomic characteristics (N = 35) Education None Elementary Secondary/vocational Higher Academic Unknown

N 1 3 17 5 6 3

Employment Homemaker Unemployed Social assistance Work (part time) Work (full time) Pensioner Student Other Unknown

well. But I understand you (the interviewer) for example, and I try to improve my language by this interview, by the communication in Dutch. That is why this contact with others is so important: Otherwise we remain like this forever ... I feel that I need to do something for myself, for my life; not just getting up, watching TV and looking after the children.” (interview citizen scientist 30) Several citizen scientists mentioned that the financial incentive motivated them. Some also stated that they appreciated being personally acknowledged for contributing to the project. One citizen scientist said she was “sick and tired” of Slotermeer’s negative reputation; she was motivated by the opportunity to prove that it was a much better neighbourhood than “outsiders” thought. Participating in the project was a positive experience for all citizen scientists. They had enjoyed group work during training and felt that learning as a group was more effective than it would have been as an individual. Carrying out interviews was perceived as a new and challenging assignment; they valued this as something very special. They reflected on the project as a new and promising approach to improve the neighbourhood’s health: “I think it is a beautiful way to collect people’s ideas and to use that information to do something good for them. At first I thought, ‘Healthy Slotermeer,’ what’s that? It is useless! But after I had joined the project I saw how effective this can be.” (interview citizen scientist 22)

N 17 4 1 3 1 3 1 3 2

Monthly income